Patient Forms, Map and Directions to Lake Elmo Office

Your first visit to Grace Dental establishes a vital foundation for our relationship with you. During the first visit, we make sure to obtain important background information, like your medical history, and give you time to get to know your doctor. To understand what to expect for your first visit to our practice, please read through this page. You'll find all the practical information you need, such as a map and directions to our office, practice hours, payment policies and more. There's also background information about our committed staff and our first visit procedures. You can even save some time at your first visit by printing out and completing the patient forms in advance of your appointment.

Mission Statement
Our practice is working together to realize a shared vision of uncompromising excellence in dentistry.

To fulfill this mission, we are committed to:

• Listening to those we are privileged to serve.
• Earn the trust and respect of patients, profession, and community.
• Exceed your expectations.
• Ensure a creative, challenging and compassionate professional environment.
• Strive for continuous improvement at all levels.

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Patient Forms
The following forms can be printed, completed and brought with you to your appointment. They require the free Adobe Reader to view and print them.

• Registration, Medical and Dental History Form

1. Click here for the Grace Dental Registration, Medical and Dental History Form. This form requests Patient Confidential Information, Responsible Party, and Dental Insurance Information, and includes the Acknowledgement of Receipt of Notice of Privacy Practices, and the Patient Consent for Use and Disclosure of Protected Health Information.
   Although dental personnel primarily treat the area in and around your mouth, your mouth is a part of your entire body. Health problems that you may have or medication that you may be taking could have an important interrelationship with the dentistry you will receive.

• Transfer of Patient Information

2. Click here for the Grace Dental Request for Transfer of Patient Information.

• Notice of Privacy Practices

3. Click here for the Notice of Privacy Practices. This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

• New Covid-19 Forms

4. Click here for the Covid-19 Pandemic Emergency Dental Treatment Notice and Acknowledgement of Risk Form
5. Click here for the Covid-19 Pandemic - Patient Disclosures

In order to view or print these forms, you will need Adobe Acrobat Reader installed. Click here to download it.

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What To Expect
Being well-prepared for your appointment will ensure that the doctor has all of the needed information to provide the best possible care for you. It also will help relieve any unnecessary anxiety you may be feeling. Educate yourself on your symptoms by reviewing the content on this Web site. Also, take some time to review our staff page and familiarize yourself with the doctors. We look forward to your first visit.